500,000 Medicaid beneficiaries with diabetes to lose coverage by 2034

Almost 500,000 Medicaid beneficiaries with diabetes will lose healthcare coverage by 2034, according to a new study sponsored by the American Diabetes Association. Those most affected are patients who live in rural communities and states that expanded their Medicaid programs following the Affordable Care Act (ACA), the analysis found.

About 1.5 million Medicaid enrollees with diabetes will be subject to new cost-sharing by 2029. Average cost-sharing could add up to $1,000 per year in new out-of-pocket costs in some states.

“The extreme loss of healthcare coverage we’re anticipating among the diabetes population as a result of recent changes to the Medicaid program will have a devastating impact on people with diabetes and lasting repercussions across the U.S. healthcare system — driven by increased hospitalizations, complications from diabetes, and emergency room care,” Lisa Murdock, the ADA’s chief advocacy officer, said in a news release.

An estimated 29.1 million people in the United States have diagnosed diabetes, according to the CDC. Adults with low incomes who lack consistent healthcare coverage experience poorer blood glucose management and require more medications to manage their diabetes long term than people who do not regularly experience lapses in coverage, according to recent research published in JAMA Health Forum.

The ADA research was conducted by Health Management Associates and used Congressional Budget Office analysis and Medicaid enrollment and claims data through the CMS’ Transformed Medicaid Statistical Information System to provide an estimate of state-level Medicaid enrollment losses and cost-sharing implications.

This analysis found that state provider taxes will account for about 45% of projected coverage losses, according to recent research in JAMA Health Forum. Other reasons for coverage loss will be eligibility assessments, community engagement rules and plans that limit erroneous payments. Most people with diabetes who will lose their Medicaid coverage live in states that expanded their Medicaid programs following the Affordable Care Act.

People with diabetes in rural areas who are expected to lose Medicaid coverage make up about 18% of coverage losses nationally. But those in southern states will be impacted the most. The fraction of rural enrollees with diabetes who could lose coverage is as high as 58% in southern states.

The ADA study also assessed whether the recent expiration of enhanced premium tax credits in the ACA program could lead to interrupted coverage in the individual market for 654,000 people with diabetes. As many as 654,000 individuals with diabetes enrolled in ACA individual market plans are projected to lose coverage between 2025 and 2027. About 70% of the ACA individual market plan coverage losses are expected in the southern region of the United States.

A survey released last month by the ADA found that about 72% of people say they pay more than $35 per month for insulin, and nearly 40% pay more than $150 a month. High copay costs also impact people who make between $75,000 and $99,000; among these patients, 55% say they pay more than $150 a month for their insulin.

The Inflation Reduction Act in 2023 capped insulin copays at $35 for those with Medicare Part D. At the same time, pharmaceutical companies, including Lilly, Novo Nordisk and Sanofi lowered costs for some insulins. But these efforts didn’t lower costs for many of those with diabetes who need insulin.

New federal legislation has been introduced to limit copays for insulin within commercial insurance. Bipartisan legislation introduced in the Senate in May 2026 would cap cost-sharing under private health insurance and provide a program for the uninsured to access insulin.

The Senate bill, Affordable Insulin Now Act of 2026 (S.451) was introduced by several senators, including Sen. John Kennedy, a Republican from Louisiana; Jeanne Shaheen, a Democrat from New Hampshire; Susan Collins, a Republican from Maine; and Reverend Raphael Warnock, a Democrat from Georgia.